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Effects of Pain and Prescription Opioid Use on Outcomes in a Collaborative Care Intervention for Anxiety.
MedLine Citation:
PMID:  23370069     Owner:  NLM     Status:  Publisher    
OBJECTIVE:: To determine the effects of pain and opioid pain medication use on clinical and functional outcomes in 1004 primary care patients with an anxiety disorder randomized to receive the Coordinated Anxiety Learning and Management (CALM) collaborative care intervention (cognitive-behavioral therapy and/or medication) versus usual care. METHODS:: A total of 1004 patients with panic disorder, generalized anxiety disorder, social anxiety disorder, or posttraumatic stress disorder were randomized to CALM or usual care. Outcomes at 6, 12, and 18 months were compared in patients with and without moderate pain interference (for the entire anxiety disorder group and then just those with comorbid major depression) and in patients taking and not taking opioid medication (entire group, just those with comorbid major depression, and just those with moderate pain interference). RESULTS:: Patients with pain interference and patients taking opioid pain medication were more anxious [Brief Symptom Inventory anxiety subscale] and disabled (Sheehan Disability) at baseline, improved over time at similar rates, but at 18 months had lower response and remission rates. There was no moderating effect on the intervention. In patients with comorbid major depression, patients using opioid medications showed a trend for less disability improvement over time, and in patients with pain, patients using opioids showed less sustained anxiety response at 18 months. CONCLUSIONS:: Anxious patients with pain benefit as much as those without pain from cognitive-behavioral therapy and medication treatment. Among patients with pain, however, there is some evidence of a reduced anxiety treatment response in those taking opioid medication, which should be further studied. TRIAL REGISTRATION:: Identifier: NCT00347269 (
Peter Roy-Byrne; Mark D Sullivan; Cathy D Sherbourne; Daniela Golinelli; Michelle G Craske; Greer Sullivan; Murray B Stein
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-1-30
Journal Detail:
Title:  The Clinical journal of pain     Volume:  -     ISSN:  1536-5409     ISO Abbreviation:  Clin J Pain     Publication Date:  2013 Jan 
Date Detail:
Created Date:  2013-2-1     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8507389     Medline TA:  Clin J Pain     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Departments of *Psychiatry and Behavioral Sciences †Bioethics and Humanities, University of Washington, Seattle, WA ∥Department of Psychiatry ¶South Central VA Mental Illness Research, Education, and Clinical Center, University of Arkansas for Medical Sciences, Little Rock, AR ‡RAND Corporation, Santa Monica §Department of Psychology, University of California Los Angeles, Los Angeles Departments of #Psychiatry **Family and Preventive Medicine, University of California San Diego, La Jolla, CA.
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